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Process-evaluation alongside a cluster-randomized trial examining the effectiveness of the 'SELF-program' on nurses'
Michel Bleijlevens1,2, Janneke de Man-van Ginkel3, Gerard van Breukelen4
1Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, the Netherlands.
International Journal of Nursing Studies Advances
|April 10, 2026
Summary
The SELF-program improved nurses' encouragement behavior in nursing homes, enhancing resident self-reliance. Despite challenges like staffing shortages, the program showed positive implementation and outcomes, warranting wider use.
Area of Science:
- Gerontology
- Nursing Science
- Healthcare Management
Background:
- The SELF-program is a theory-based training designed to enhance nurses' encouragement of resident activity.
- It aims to indirectly improve nursing home residents' self-reliance in daily living activities.
- This study evaluated the implementation, impact mechanisms, and contextual factors of the SELF-program.
Purpose of the Study:
- To conduct a process evaluation of the SELF-program within a cluster randomized trial.
- To assess the implementation, mechanisms of impact, and contextual factors influencing the program's effectiveness in Dutch nursing homes.
Main Methods:
- A mixed-methods process evaluation was conducted alongside a 9-month cluster randomized trial.
- Data were collected via checklists, evaluation forms, logbooks, questionnaires, and focus-group interviews with nurses and trainers.
- Quantitative data were analyzed using mixed linear regression, and qualitative data using deductive coding.
Main Results:
- Nurses reported high satisfaction with the SELF-program's interactive content and team approach.
- High fidelity implementation was observed (90% session completion), though attendance averaged 60% and varied.
- Significant improvements were noted in nurses' attitudes, self-efficacy, and intentions regarding activity encouragement, with small to medium effect sizes.
Conclusions:
- The SELF-program was well-received and implemented, positively influencing mechanisms for nurses' activity encouragement behavior.
- Minor adjustments and improved attendance could further enhance the program.
- Given positive outcomes, widespread implementation of the SELF-program is recommended for nursing home settings.
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